Break away from 'heroic' leadership

I attended an Empathy and Compassion in Society conference at Friends House in London in November last year. The conference talked about both leadership and how the lack of effective leadership has contributed to the problems we too often see in the NHS.

I was there because I am increasingly concerned that we are replacing the language of caring with that of the market.

‘The peloton style of leadership works for cyclists and with some imagination it can work for the NHS’

Part of the pack

It has caused me to reflect that we now have the perfect opportunity to do things differently. I don’t mean in terms of NHS commissioning or service design, but to refocus on what matters most to patients − kindness, caring, compassion and, perhaps more importantly, how our leaders and leadership can become the vehicle for this.

Leadership, that ubiquitous word, is (rather like integration) touted as the solution to all the woes facing the NHS. The argument goes that if only there was more “disruptive innovation” led by “heroic” individuals who are willing to make sacrifices and march their army of managers and clinicians into a battle against waste and insolence, then we would have an NHS fit for the future.

My view is different. I feel it is time to rethink leadership. In the spirit of self-help author Anthony Robbins, I think we need to stop doing what we have always done and try something different. Perhaps it is time to try “peloton style” leadership.

‘In education there have been many attempts to promote distributional leadership and highlight how leadership emerges from a group’

A peloton is the main pack of riders in a road cycling race, with the riders at the front sheltering the rest of the pack from the wind. Taking turns at the head of the peloton allows the whole field to travel faster and for longer than any one rider could manage alone. No rider, no matter how strong, can win without cooperating with others.

Together the group focuses its attention on the epic task in hand (cycling a ridiculous number of miles) and deals with adversity (such as difficult weather conditions and terrain). This peloton style perfectly matches the idea that leadership is a symbiotic relationship between those who choose to lead and those who decide to follow.

No more heroes

The peloton style of leadership works for cyclists and I think with some imagination (and possibly without the lycra) it can work for the NHS.

What’s more, the peloton is the perfect model for the NHS to follow because it encourages competition to be the best while everybody works together to move the whole thing forward.

I am not the first person to champion this idea. In the field of education there have been numerous attempts to promote distributional leadership and highlight how leadership emerges from a group or network of interacting individuals.

‘We need to move away from an environment where micro-managers demand targets and collaborate little’

A report in 2011 by the King’s Fund called for recognition that the old “heroic” individual leadership model − the “turnaround chief executive” − needed to make way for leadership being shared across the care system, “from the board to the ward” and away from “pace setters”.

New environment

The hope that the NHS will be transformed by exceptional heroic leaders is unrealistic, unsustainable and rather misogynistic. The idea of a dominant, invariably male, leader perched on top of an organisational hierarchy is paradoxical in the complex, value-laden, now predominantly female NHS.

Binney et al, in their book Living Leadership, point out: “The identification of leadership with lone individuals standing apart and wrestling their organisations into shape paradoxically disempowers leaders and stops them doing their best.” Overburdening leaders and paralysing followers only leads to poor patient care and demoralised staff.

We need to move away from an environment where micro-managers demand targets and collaborate little. We need to move towards a peloton style leadership where boundaries of leadership are widened and where people work together to pool their initiative, talents, distinct perspectives, energy and expertise. In this environment, the outcome will always be richer and greater than the sum of their individual actions.

Leadership, as Roy Lilley has written in his blog, is about “creating the space for people to do the best job they can… creating opportunities to do the best job they can”. The peloton, with everyone involved working to the best of their ability for the good of the team, is the perfect example of this.

Dr Clare Gerada is chair of the Royal College of GPs

Readers' comments
(11)

Anonymous | 23-Jan-2013 8:50 am

like the concept, but it's 'square pegs in round holes'!!Since I moved into Healthcare, after 18years in other sectors, I have been shocked by the ego driven leaders - both within Trusts, the DH, NHS confed and the regulators of the service (and, sadly, the think tanks and commentators on health).. with such an ego centric culture the peloton would soon break down

I agree with no more heroes but take it in turns leadership is not the answer nor is leadership at every level. The obsession with leaders has become unhelpful as a previous article in HSJ argued what we need is less leadership and more management. Or put another way less vision and rhetoric and more recognition for the skills necessary to manage the service.

Clare, could you please provide some successful examples of "peloton leadership".

All I see is a bunch of cyclists following a route set (and cleared and marshalled) by the race organiser under the direction of their respective team leaders and team management, i.e. the individual riders show no leadership at all.

Perhaps this just reflects the limitations of the analogy. I rather like the idea; thought provoking, perhaps we should take a spoonful of this idea and mix it with 'no plan survives first contact with the enemy' head north and deal creatively with the unforeseen issues as a team as they arise in real time an 'ants in lycra' model?

Via Twitter, Clare said that the Hurley Group practices peloton leadership, but when you look at their structure chart http://www.hurleygroup.co.uk/wp-content/uploads/2012/09/Sept-2012-Structure-for-website.pdf they seem to have an awful lot of structure for an organisation where everyone is supposed to be taking the lead from time to time, which would seem to suggest a very flat organisational structure.

Interesting no one has picked up the compassion narrative which is fundamentally flawed, not because compassion is not essential (it absolutely iu) and is often missing but because it focusses on character and behaviour of front lthe ine staff without asking what management, leadership or workplace pressures ground compassion out of them.

Most leaders still confuse the difference between leadership and management In the fire service Chris Keeble spoke more about building followship was critical for leaders . Main point was you have to earn leadership by building followers . His report bridging the gap would still be relevant today for the NHS

The analogy may have some weaknesses, as pointed out above, but is a very good one for making the point that it is possible to compete and collaborate at the same time whilst improving overall collective performance. This happens in the private sector - companies compete for some work, collaborate for others but both together can drive them all to innovate, adapt and perform better as a whole.

Good piece for stimulating discussion. I too have called for more evaluation of leadership along with a stronger emphasis on management, which with administration has been somewhat sidelined by an over-emphasis on leadership.

But perhaps the most important variable to take into account is the relationship between developing a stronger NHS ethos of caring and compassion, and how these qualities are viewed in society as a whole.

I would argue that whilst I share Clare's aims, unless we are seen to be a more caring and compassionate society - as is the case in many other countries - we may have limited success in changing NHS (and social care) culture.

Finally, and this is another way of looking at Clare's points, there is an increasing gulf between the multi-disciplinary, team-based approach of clinical care and treatment with the hierarchical nature of leadership and management in the NHS. NHS management needs to be reinvented so that it mirrors clinical care - perhaps then we would stand a better chance of developing the improved behaviours that we talk about.

Leadership is not a rocket science. Leadership concept is ‘mini me’ so bullying leaders creates more bullies around him/her but a good leader creates more good leaders around him/her. In our NHS where there is ‘Club culture’ Old boy’s network, discrimination, bullying and so on, we do not appoint right leaders. This culture is more rife amongst medical and nursing profession. One has to simply look at the diversity of leaders in many Trust, Colleges and even the Commissioning Board!

Sadly there is no true equality and diversity. So many good doctors and nurses with excellent leadership skills are not nurtured, encouraged to take on leadership roles and many get fed up and lose interest in being and becoming leaders.

Having been a Medical Director and taken many leadership roles in the NHS, I can only speak for doctors. I am convinced that sadly only 10% of our doctors have true leadership skills and by not encouraging women and BME doctors with true leadership skills we are losing out on nearly 10,000 good doctors with fantastic leadership skills from taking active part in leadership like Clinical Directors, Divisional Medical Directors and eventually becoming Medical Directors.

Leadership is about intimacy and good relation with our staff and making them feel valued, involved, engaged, nurtured and supported. It is about working with them putting patients at the heart of everything we do and having safety culture, supportive and learning culture, moving away from ‘blame culture and a culture of accountability for all including the leaders and providing the best, safe and effective care to all our patients. Leadership is the key and leaders should only be appointed for their merit and all leaders should be performance managed for their behaviour, values and beliefs and should have feedback from everyone who is affected by their leadership.

Organisational leadership, culture and energy are the key to the success or the failure of the organisation. Leaders should only be appointed on merit and nothing else.

Subscribe to HSJ

HSJ is the essential resource on health management and policy, giving you invaluable insights to keep you up to speed with developments in the fast moving health service. Pick one of our packages and get full access to hsj.co.uk plus the magazine and iPad app.

About HSJ

Health Service Journal is your source for NHS news and NHS jobs. Log on or subscribe to stay on top of health management and policy issues.
From commissioning to mental health, from policy making to the front line, HSJ offers unrivalled news, analysis and opinion.